Notice of HIPAA Policy

The terms in this notice are effective October 8, 2020.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
is a federal law designed to protect you, the patient, with regards to how your personal medical information is used and shared by your medical provider(s). As a lactation educator and counselor, I will keep a record of our counseling session, but any personal health information will be kept confidential.

Your rights under HIPAA:

Access to records: You may request a copy of your records, paper or electronic, at any time. I will provide these within a reasonable amount of time.

Change to records: Within reason, you have the right to ask for a change to your medical record to change inaccurate information within your personal health record.

Disclosure of records: Record history will be available up to six years in the past. You have the right to ask who your records have been shared with and why. I will provide you a list within a reasonable amount of time. I will provide one list each year free of charge, but a reasonable, cost-based fee will be assessed for any additional requests within 12 months.

Restriction of sharing: You can put limits on who I am able to share your personal health record with. However, I am not required to agree to your request if such request would affect your care or if I am otherwise required by law to share the restricted information.
Access to notice: You may request a copy of this privacy notice, paper or electronic, at any time. I will provide this to you within a reasonable amount of time.

Designation of someone to act on your behalf: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. I will make sure that person has authority before I take any action.

File a complaint: You can file a complaint if you believe your privacy rights have been violated using guidance below. I will not retaliate against your for filing a complaint.

How I use your information:

To treat you: This includes sending the information to other health professionals who are treating you.
To bill for services rendered: This includes submitting bills to health plans and other entities for payment.
To run my organization: This means I can use your information to treat you, improve your care and contact you when necessary (such as a follow-up appointment or for an additional service I think may benefit you).
To comply with the law: This means that state law may require me to share your health information for a specific purpose (e.g., a workers’ compensation claim). The Privacy Rule allows me to share this information.
To address workers’ compensation, law enforcement and other government requests.
To respond to lawsuits and legal actions: If served with a subpoena or otherwise required by a court of competent jurisdiction, I may be compelled to share your health information.
In these cases, I will never share your information unless you provide written permission:

Marketing purposes
Sale of your information
You may also request that I share your information with other parties beyond what has been discussed above. To do so, you must submit a request to me, in writing, stating your need and to whom I should send the information. I will only provide as much information as is needed for the purpose stated, nothing more.

I am the privacy officer for my one-person practice. My name and phone number are Sarah Brock, 816-810-8124. Should you have a complaint, please come to me and I
will work to resolve it quickly in a way which will keep you protected and comply with the law. If you have additional complaints, you can use your right under HIPAA to go to the U.S. Department of Health and Human Services Office for Civil Rights. More information for their office can be found at